Neck Lump

The most common causes of enlarged lymph nodes among younger people include the following:

• Reaction to nearby infection (such as a cold or a throat infection)

• Direct bacterial infection of a lymph node

• Certain bodywide (systemic) infections

One or more neck lymph nodes often enlarge in response to an upper respiratory infection, throat infection, or dental infection. In such cases,the nodes are soft and usually not tender. They typically return to normal shortly after the infection goes away.

Sometimes bacteria can directly infect a lymph node (called lymphadenitis). These infection include cat-scratch disease, toxoplasmosis, and actinomycosis. In such infections, the infected nodes are quite tender to the touch.

Certain systemic infections typically cause several lymph nodes to enlarge, including some in the neck. The most common of these infections are mononucleosis, human immunodeficiency virus (HIV), and tuberculosis.

A much less common but more serious cause of enlarged lymph nodes is

• Cancer

Cancerous (malignant) neck lumps are more common among older people, but they may occur in younger people. The cancerous lump may be any of the following:

• A cancer of a nearby structure, such as the mouth or throat, that has grown into the neck

• A cancerous lymph node, which may occur when a cancer spreads (metastasizes) from a nearby structure or from more distant parts of the body

• A cancer that begins in the lymphatic system (lymphoma).

Cancerous lumps are not painful or tender to the touch and often are rock-hard.

Cysts are hollow, fluid-filled masses that are usually harmless unless they become infected. Some cysts in the neck are present from birth because of abnormalities that occurred during fetal development. Sometimes cysts develop in the skin (epidermoid cyst), including in the skin of the neck.

A salivary gland under the jaw (submandibular gland) can enlarge if it is blocked by a stone or becomes infected or if cancer develops in it.

The thyroid gland, which is in the middle of the neck just above the breastbone, can enlarge. The most common type of enlargement is goiter, which is noncancerous (benign). Thyroid cancer and thyroid inflammation (thyroiditis) are less common.

In people with a neck lump, certain symptoms and characteristics are cause for concern. They include

• A very hard lump

• Sores or growths in the mouth

• Difficulty swallowing and/or hoarseness

• A new lump or lumps in an older person

In general, painless lumps are somewhat more worrisome than painful ones.

People who have any type of neck lump for more than a few days should see a doctor, particularly people with warning signs. People with other symptoms (such as fever) should see a doctor as soon as possible.

Doctors ask questions about the person's symptoms and medical history and do a physical examination. What doctors find during the history and physical examination helps decide what, if any, tests need to be done.

During the medical history, doctors ask about the following:

• Symptoms of colds (such as a sore throat, sneezing, and a runny nose), and throat infections (such as pain when swallowing), and dental infections (such as toothache)

• Symptoms of cancer in the neck (such as difficulty speaking or swallowing) as well as risk factors for cancer, particularly smoking and drinking alcohol

• Risk factors for HIV and tuberculosis infection

During the physical examination, doctors focus on the ears, nose, and throat (including the tonsils, base of the tongue, and thyroid and salivary glands). They look for signs of infection or abnormal growths, including looking down the throat with a mirror or a thin flexible viewing tube (laryngoscopy). They also feel the neck lump or lumps to determine whether the lump is soft, rubbery or hard and whether it is tender.

If there is an obvious source of infection (such as a cold or a sore throat) or if the person is young and healthy and has a tender lump present for only a few days, no tests are needed immediately. Such people are watched closely to see whether the lump goes away without treatment. If it does not go away, tests are needed.

Most other people should have a complete blood count (CBC) and a chest x-ray. If younger people have no risk factors for cancer or findings that suggest cancer (such as mouth growths), imaging tests are often done, sometimes followed by biopsy. For older people, particularly those with warning signs or risk factors for cancer, doctors often do several tests to look for a source of cancer before they remove a piece of the lump (a needle biopsy) or the entire lump for testing (an excisional biopsy). Tests often include blood tests and computed tomography (CT) or magnetic resonance imaging (MRI) of the head and neck. Ultrasonography is preferred for children to avoid radiation exposure and may be used in adults if doctors suspect a thyroid mass. In children, infection is the most common cause of neck lumps, So before an imaging test is done, children are usually first given antibiotics to see if the lumps go away.

To look for cancer originating in other parts of the body, doctors usually take x-rays of the upper digestive tract, a thyroid scan, and a CT scan of the chest. Direct examination of the larynx (laryngoscopy), lungs (bronchoscopy), and esophagus (esophagoscopy) with biopsies, done at the same time, may be needed.